Your kid won’t stop scratching her scalp. When you look closely, you’re a little (okay, a lot!) freaked out because you think you just saw lice. First things first: Lice aren’t a sign of poor hygiene. “Lice are transferred [by] contact between people from hair and by sharing hats or brushes,” says Meghan Feely, MD, a board certified dermatologist in New Jersey and New York City who serves as a clinical instructor at Mount Sinai’s Department of Dermatology.

“It doesn’t matter whether hair is clean or dirty. Lice are on the search for another human host.” Anybody with any hair type can get lice, though kids in pre-K and elementary school are most likely to be affected. Here’s what you need to know to say buh-bye to each and every louse:


Okay, there’s definitely an ick factor, but stay calm so your kid stays calm. Head lice aren’t known to spread disease, and they can’t fly or jump—they can only crawl. Your first order of business is to make sure you really see lice. Sometimes dandruff, sand or lint may resemble lice at first glance. Have your child sit under a bright light, part sections of the hair and look for fast-moving adult lice (tan or grey bugs the size of a sesame seed) or eggs (yellow, brown or tan oval-ish specks that stick to individual hairs close to the scalp), also called nits. Check everyone else in the house, but don’t worry about pets, who can’t get head lice from people.


If you’ve seen evidence of lice or nits, it’s time to treat with over-the-counter (OTC) shampoo. “It’s reasonable to try an OTC product you can get at the drugstore first,” says A. Yasmine Kirkorian, MD, a dermatologist and assistant professor of dermatology and pediatrics at Children’s National Health System at George Washington University School of Medicine and Health Sciences. “These products are inexpensive, and you won’t have to make a visit to the doctor’s office.”

Typically, these are shampoos that contain permethrin or pyrethrins. Other treatments, such as products containing dimethicone, suffocate the lice but aren’t practical for most families (they must be left in place for hours and leave hair greasy). The American Academy of Pediatrics says to avoid home remedies like mayonnaise and olive oil, since there’s no scientific evidence that they work.

To begin, wash your child’s hair with regular shampoo, but don’t use conditioner or conditioning shampoo, which coat the hair and make it too slippery for the medicated product to adhere, says Kirkorian. Leave the hair damp, put a towel on your child’s shoulders and face, then apply the medicated shampoo (which has a lotion-like texture) from the hair roots to the tips. “Be attentive to areas along the hairline and behind the ears where lice are often found,” says Kirkorian. Leave it on your child’s head for the time recommended on the label, then rinse. Wait two days to wash hair so the product continues to work.


Follow the box instructions, but generally, you’ll need to retreat in about seven to nine days. “These OTC products only kill adult lice, not nits,” says Feely. That’s why you need a second treatment to take care of any newly-hatched nits. If you still see lice after that, call your pediatrician or dermatologist. He or she can prescribe medications such as benzyl alcohol lotion, malathion, spinosad and ivermectin lotion. These are usually applied to dry hair, then rinsed after a period of time. They may require additional treatment if live lice are seen (except for ivermectin, which is only one application). Use the lice comb that came with the shampoo daily for two to three weeks to make sure they’re gone for good.


Now you’ve got even more work to do. The American Academy of Dermatology says that anything that came in contact with the person with head lice in the last two days needs to be cleaned to prevent a reinfestation. Brushes and combs should be soaked in hot water (130 degrees or higher) for ten minutes. Clothes, sheets, blankets and towels should be washed in hot water and dried on the hottest setting in the dryer. Seal stuffed animals, hair accessories, helmets, hats or anything else that isn’t washable in a plastic bag for two weeks. Fingers crossed, you can breathe a sigh of relief now that this parenting adventure is finally behind you.

—Arricca Elin SanSone is a New York-based health and lifestyle writer.

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